Screening for Prostate Cancer

Frimley Health NHS Foundation Trust

 very largeHistorically, the assumption has been that screening would routinely mean checking the prostate-specific antigen (PSA) levels. This  is a controversial subject in the international medical community for several reasons.

PSA tests are unreliable and can suggest prostate cancer when no cancer exists (a false-positive result).  Furthermore, around 1 in 7 those with prostate cancer have normal PSA levels (a false-negative result), so many cases may be missed.

The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. So this test is discredited.

However, for high risk groups such as men on West African genetic heritage, PSA tests and if possible an MRI are an essential in my view

These days there is growing interest in using a simplified, much quicker and cheaper biparametric (bp) MRI as a screening test in much the same way than a Mammogram is used to screen for breast cancer in women.

The pioneering Prostagram program led by Professor Hashim Ahmed (Imperial) using a sample of 540 men indicated this would be a robust test but further research was required.

Prostate Cancer UK is about  to start a very large a long term research program the TRANSFORM trial using amongst other tests a bpMRI for screening. See the page after this one.

Meanwhile, UCLH have conducted the PRIME trial using bpMRI and results will be published soon. Infact Dr Clare AAlen at the recent EAU congress that the results indicated that bpMRI was as good as the complex mpMRI in terms of detecting prostate cancer. This has resulted in several private imaging centres offering bpMRI as a screening test. You can find out more in the pages following this one.

The other area that is emerging is genetic and molecular testing. You will find information on two of these new tests on the following pages. One is Proclarix, which is already in use for determining whether or not to biopsy following equivocal MRI scans and the other being the Stockholm 3 test. Both these tests are suitable for men with increased risk of prostate cancer and can give an accurate prediction of risk. However, although commonly used in the Nordic countries, it will be several years if ever before it may be available on the NHS. In the meantime it is only available privately. You can find more information on dedicated pages in this section. 

As to Risk, it is indicated if a man has the following signs in their families:

• Relatives with early onset prostate cancer (diagnosed before age 55)
• 3 first degree relatives (brother, son, father) diagnosed with prostate cancer
• Ashkenazi Jewish ancestry and breast, ovarian or prostate cancer
• Prostate cancer and two relatives with breast or ovarian cancer
• Prostate cancer and male breast cancer, or ovarian cancer or bilateral breast cancer
• Prostate cancer and early onset bowel or womb cancer (before age 50)
• Prostate cancer and 2 relatives with bowel or womb cancer